Professional Documents
Culture Documents
State __________________ )
Subscribed and Affirmed )
County of __________________ )
(NOTE: If mailed Return Receipt Requested, the return receipt must be attached to this
Certificate of Service.)
If person serving is NOT a sheriff or sheriff’s deputy, address and phone number of
server: (Print) ________________________________________________________
__________________________________________________________________
(Signature): _______________________________________________________,
Mailer/Server
(Printed name): ____________________________________________________
A notary public or other officer completing this certificate
verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the
truthfulness, accuracy, or validity of that document.